Getting up at night to go to the toilet – nocturia – is one of the most common and most underestimated complaints in a urology practice. Broken sleep leads to tiredness, poor concentration and higher blood pressure, and in older people to a risk of falling in the dark. The good news: in a large proportion of patients, changing a few habits noticeably reduces night-time trips to the toilet, even before medication is needed.
The causes fall into two large groups: too much urine is produced at night (nocturnal polyuria – roughly more than a third of the 24-hour amount), or the bladder holds less, as with an enlarged prostate, an overactive bladder or inflammation. Quite often the two are combined. The tips below are aimed mainly at the first group, but they also help with the second.
Keep a diary for three days
A valuable way to prepare before the consultation is a bladder diary for two to three days: the time of each visit to the toilet, the approximate amount (a measuring jug in the bathroom is enough), what and how much you drank, and when you went to bed and got up. This makes it clear whether you pass large amounts at night – in which case the problem lies in urine production – or get up often to pass small amounts, which points to the bladder or the prostate. The diary saves tests and is the first thing Dr Penev looks at in a consultation for frequent and night-time urination.
Move your fluids to the first half of the day
Do not reduce the total amount of fluid – dehydration concentrates the urine and irritates the bladder. Instead, drink most of it by late afternoon, and in the last two to three hours before bed limit yourself to a few sips. Soup at dinner, watery fruit and a cup of herbal tea “for sleep” are fluids too. Before going to bed, pass urine, wait a minute and try again – that way the bladder starts the night empty.
Caffeine, alcohol and salt
Caffeine has a diuretic effect and irritates the bladder – not only in coffee but also in black and green tea, cola and energy drinks, so it is best to have the last one by early afternoon. Alcohol in the evening suppresses the hormone that keeps water in the body and increases urine at night. A salty dinner, cured meats and ready meals increase thirst and make the body retain fluid, which it then gets rid of precisely at night. Try two weeks of less salty dinners and compare your diary.
Raise your legs in the afternoon
If your ankles are slightly swollen in the evening, fluid has collected in your legs during the day, and as soon as you lie down it returns to the circulation and the kidneys pass it as urine. Lie down for an hour or two in the afternoon with your legs above the level of your heart, move around more and ask your doctor whether compression stockings are suitable for you. That way the fluid is passed before you go to bed.
Check when you take your medicines
Water tablets (diuretics) taken in the evening almost always lead to getting up at night; often they can be moved to the morning or early afternoon, but only after talking to the doctor who prescribed them. Some blood pressure medicines cause swollen legs and indirectly increase night-time urine. Do not stop or reschedule anything on your own – bring a list of your medicines to the consultation.
Look after your sleep
Sometimes you wake up first and only then head for the toilet – with insomnia, pain or snoring with pauses in breathing (sleep apnoea), which in itself increases night-time urine. If your partner describes such pauses, mention it to your doctor. Keep a regular bedtime and a cool, dark bedroom, and leave a dim night light on the way to the bathroom – a fall is more dangerous than getting up itself.
When to see a doctor
Book an appointment if, despite these measures, you get up two or more times every night, if your stream is weak or hard to start, or if you have sudden strong urges or leaking, stinging, pain or blood in your urine. Severe thirst and weight loss point to diabetes, swelling and shortness of breath to the heart; both need a consultation. Do not wait for a booked appointment if you cannot pass urine with a full, painful bladder, or if you have a temperature and chills together with urinary symptoms – these are emergencies for the emergency department.
At his practice in Plovdiv, Dr Penev reviews the diary, does an ultrasound scan with measurement of the residual urine, assesses the prostate in men and, with a weak stream, measures the urine flow if needed. Treatment follows the cause: for an enlarged prostate and an overactive bladder there are well-studied medicines, and for nocturnal polyuria a medicine that reduces night-time urine production and is used under medical supervision. More about the consultation on the page about urinary problems.
A run of nights of unbroken sleep is often a matter of two weeks of discipline with fluids, salt and the diary. If that is not enough, book an appointment with Dr Penev in Plovdiv or Karlovo and bring your diary – it is a direct route to the cause.
Frequently asked questions
Is it normal to get up once a night to go to the toilet?
Getting up once, especially after the age of 60, is usually not a sign of illness. Two or more times every night already disrupts sleep and is worth looking into.
If I drink less water, will I stop getting up at night?
Not necessarily. Cutting down on fluids overall leads to more concentrated urine, which irritates the bladder, and to dehydration. What works is moving your fluids to the first half of the day, not giving them up.
Is there a medicine for night-time urination?
Yes, but the choice depends on the cause – medicines for the prostate, for an overactive bladder, or a medicine that reduces the amount of urine produced at night. The last one requires blood tests to be monitored, especially in older people, so it is prescribed only by a doctor.
What causes night-time urination in women?
Most often an overactive bladder, nocturnal polyuria, changes after the menopause or an infection. The advice on fluids, caffeine and salt applies just the same, and a consultation identifies the specific cause.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.